Sistema Regional de Información
en línea para Revistas Científicas de América Latina,
el Caribe, España y Portugal

Background: Infections caused by extended-spectrum beta-lactamases enterobacteria (ESBL-EP) have implications for neonatal morbidity and mortality. Aim: To describe the prevalence of ESBL-EP in neonatal sepsis and associated factors. Methods: A prospective cohort study was conducted from August 2016 to August 2017; newborn babies (NB) hospitalized in the Hospital Civil de Guadalajara “Dr. Juan I. Menchaca” were included. The ESBL-EP were investigated by double-disk synergy test and its association with clinical and demographic characteristics of the NB. Results. A total of 1,501 hospitalized NB were studied, with an average gestational age of 36.3 weeks. They were diagnosed 196 neonatal sepsis events, the most frequent etiologies were enterobacteria (45.5%). Resistance to ampicilin was found in 88.8% and to broad spectrum cephalosporins in more than 42% of the strains; 22.9% of them were ESBL phenotype. Apgar ≤ 7 at five minutes of life (OR 4.6; 95% CI 1.47-14.6) and gestational age < 37 weeks (OR 5.4; 95% CI 1.04-27.) increase the risk. Conclusion: In enterobacteria that cause neonatal sepsis, 22.9% were EP-ESBL; infection was more likely in patients with Apgar ≤ 7 at five minutes of age and in preterm infants.

La otitis media aguda (OMA), una de las infecciones más comunes de la infancia, es la causa más frecuente de visitas al médico, de consumo de antimicrobianos y de indicación quirúrgica en niños. En los últimos años se han realizado grandes esfuerzos en la prevención de la OMA, como la implementación de vacuna conjugada de Streptococcus pneumoniae, el fomento de prolongar la lactancia materna y las campañas para disminuir el consumo de tabaco, factores que han tenido impacto en su epidemiología, con reducción en la incidencia y cambios en su perfil microbiológico. El diagnóstico es básicamente clínico y, dado los cambios epidemiológicos antes descritos, se hace de vital importancia su correcto reconocimiento y el uso adecuado de antimicrobianos.

Taurolidina es un antiséptico de amplio espectro usado como solución de terapia de sellado (lock therapy) en adultos y niños portadores de catéter venoso central de larga duración (CVC) para prevenir las infecciones asociadas a CVC (IACVC). No induce desarrollo de resistencia y tiene efectos adversos leves y fugaces, lo que lo convierte en una alternativa, tanto como terapia de sellado como para la profilaxis de las IACVC, en este grupo de pacientes.

La enfermedad fúngica invasora (EFI) es una entidad que afecta pacientes inmunocomprometidos y críticamente enfermos. En los últimos años el número de pacientes con riesgo de presentarla viene en aumento, con el consecuente incremento de la formulación de antifúngicos de manera profiláctica, anticipada o empírica. Algunos estudios que evaluaron el uso adecuado de antifúngicos han mostrado que hasta 72% de las formulaciones pueden ser inapropiadas, exponiendo a los pacientes al riesgo de efectos adversos e interacciones medicamentosas, con mayores costos de la atención. Se han recomendado diferentes intervenciones para el control y el uso racional de antimicrobianos, conocidas como “antimicrobial stewardship”, las cuales se pueden aplicar al uso de antifúngicos denominándose “antifungal stewardship”. Se presenta una revisión de la literatura sobre el uso apropiado de antifúngicos y el impacto de la implementación de programas de optimización del uso de estos medicamentos en algunos centros.

Acute respiratory infections (ARI) in Pediatrics, due to its high incidence, are frequent clinical conditions in which the doctor faces the decision to indicate antimicrobials. Several are his dilemmas in these instances: Is it necessary to prescribe an antimicrobial? What criteria should you consider to solve it or do not? Which is the better choice in 2019? Dosage and treatment time to recommend the patient? The Sociedad Chilena de Infectología, observing the doctrine of the prudent use of antimicrobials, has prepared, in the hands of its specialists, an informed and updated guide for the use of antimicrobials in the acquired IRA in the community for children. It has left out the acute respiratory diseases of patients with base chronic diseases such as congenital and acquired immunodeficiencies, malformations of the respiratory tract, chronic and nosocomial infections. Each chapter includes tables at the end to facilitate quick reference and recommended readings that will deepen the concepts and basis of the recommendations given.

Strongyloidiasis is a neglected disease in Latin America. Gastrointestinal manifestations are nonspecific and duodenal obstruction is a rare complication. Here we present the case of a 31-year-old male from the central jungle of Peru, admitted due to a high intestinal obstruction, with duodenal ulcers and stenosis evidenced in the upper endoscopy. The histopathological report revealed presence of larvae of Strongyloides stercoralis. Clinical and endoscopic follow up were favorable with ivermectin treatment. There are near 20 reported cases of duodenal obstruction due to S. stercoralis. Additionally, infection by HTLV-1 was confirmed, being this a frequent association.

La gnatostomiasis es una parasitosis emergente en países no endémicos. Este nematodo zoonótico requiere del agua dulce para su ciclo de vida donde sus larvas se enquistan principalmente en peces. La migración subcutánea de las larvas produce habitualmente una paniculitis eosinofílica de rápido avance. Se describe un caso con lesión migratoria sin mejoría clínica con terapia antibiótica. La búsqueda de factores de riesgo sumado a la evolución y a los hallazgos de laboratorio hizo sospechar el diagnóstico. El consumo pescado crudo en personas que han visitado países endémicos en Sudamérica o Asia, como el caso de nuestra paciente lo fue Tailandia.

Background: Early viral detection in acute respiratory infections (ARI) is essential to establish appropriate therapy and prevent nosocomial transmission. Objective: To compare the efficacy of indirect immunofluorescence technique (IIF) with the polymerase chain reaction (PCR) to identify respiratory viruses in children hospitalized for ARI.Methods: 47 nasopharyngeal aspirates of children ≤ 2 years with ARI were included. IFI included respiratory syncytial virus (RSV), adenovirus, influenza A and B and parainfluenza. PCR also included the detection of metapneumovirus, enterovirus/rhinovirus, bocavirus and coronavirus. Sensitivity, specificity, positive and negative predictive value (VPP/NPV) and kappa correlation for RSV were estimated by IIF compared to PCR.Results: The IIF detected only RSV (29; 61.7%). PCR detected several viruses, including RSV in 26 cases (55.3%), followed by bocavirus (29.8%), rhinovirus/enterovirus (21.3%), adenovirus (14.9%) and parainfluenza (4,3%) among others, with 35.5% of coinfection. The IIF presented sensitivity: 85.7%, specificity: 73.6%, PPV: 82.7%, NPV: 77.7% and kappa: 0.5990 (95% CI, 0.3636-0.8346) for RSV.Conclusion: The IIF presents good sensitivity, but moderate specificity for RSV. However, IIF fails to detect other respiratory viruses. The introduction of PCR would improve the etiological diagnosis of ARI of viral origin.